Am Fam Physician. 2000;61(11):3458
Achieving Resolution of Achilles Tendon Problems
(Australia—Australian Family Physician, January 2000, p. 35.) The Achilles tendon has a relatively poor blood supply and a low metabolic rate. Thus, it can carry heavy loads under tension over prolonged periods without ischemic damage, but the tendon is slow to heal when injury occurs. Complete rupture usually occurs in older athletes during unusually active sports activity. The patient reports a sudden sensation in the back of the leg with or without an audible snap. The gait is limping and there may be a palpable defect in the tendon. Surgical repair is usually required. Achilles tendonitis generally develops more gradually and may be caused by repetitive stressors. Pain and stiffness are usually worse in the morning and are relieved by activity, but recur. In addition to activity, application of heat may alleviate symptoms.
Managing Patients with Somatoform Disorders
(Australia—Australian Family Physician, February 2000, p. 109, 115.) Somatizing patients express psychologic and emotional distress as physical symptoms. Somatization can present in forms ranging from vague somatic complaints and distress to full-blown conversion disorders involving paralysis or blindness. Conversion disorders are not common. The assessment of patients with somatoform disorders takes considerable time and skill to ascertain the full range of symptoms, concerns and beliefs. Patients need to be reassured that their symptoms and distress have been taken seriously before they can “reframe” and reattribute their condition. Patients respond best when they have regularly scheduled appointments with a physician or health professional designated as the case manager. Excessive testing should be avoided. Health care professionals should maintain a positive, optimistic attitude, but avoid making promises to abolish symptoms or establishing dependency in patients.
Diagnosis and Treatment of Granuloma Annulare
(Canada—Canadian Family Physician, March 2000, p. 553.) In granuloma annulare, rings or arches of red papules appear on the hands, elbows, feet, knees or ankles. Lesions may be single or multiple. The cause of this benign condition is unknown, although some patients implicate local trauma and sun exposure. Granuloma annulare is most common in middle-aged women. It is usually asymptomatic and resolves spontaneously in one half of all cases within two years. Local topical or injected steroids may assist resolution and improve cosmetic appearance. In children, observation is sufficient. Generalized granuloma annulare is often associated with diabetes and is resistant to treatment.
Management of the Patient with Osteitis Pubis
(Australia—Australian Family Physician, February 2000, p. 158.) The most common cause of groin pain in athletes is osteitis pubis, or inflammation of the pubic bone. The condition arises when muscles inserting on various surfaces of the pubic bone are stressed. Osteitis pubis occurs most commonly in athletes involved in sports such as soccer that involve twisting, turning and kicking. Complete physical examination is necessary to exclude other causes of groin or hip pain. Radiologic studies or computed tomographic examination may be helpful. Management depends on analgesia and steroid therapy, physical therapy and reduced training levels. Surgery is necessary in very few cases.